Xray : right lung upper zone shows patchy fibrocalcific changes. remaining lung fields are clear. evidence of bilateral bifid rib l anterior 4 r 3?

Consult ordering dr: Bifid ribs are congenital and usually are of no consequence and are variations of normal. Fibrocalcific disease is probably related to previous granulomatous infection. Most common is tuberculosis. In Southwest coccidiodomycosis is fungal cause. In midwest Blastomycosis is usually cause. Long term antibiotic treatment sounds like a chronic infection like one of the above. Various testing available